The 2023 ACR/EULAR Classification Criteria for Calcium Pyrophosphate Deposition Disease.

OBJECTIVE: Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease. METHODS: Supported by the ACR and EULAR, a multinational group of investigators followed established methodology to develop these disease classification criteria. The group generated lists of candidate items and refined their definitions, collected de-identified patient profiles, evaluated strengths of associations between candidate items and CPPD disease, developed a classification criteria framework, and used multi-criterion decision analysis to define criteria weights and a classification threshold score. The criteria were validated in an independent cohort. RESULTS: Among patients with joint pain, swelling, or tenderness (entry criterion) whose symptoms are not fully explained by an alternative disease (exclusion criterion), the presence of crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid are sufficient to classify a patient as having CPPD disease. In the absence of these findings, a score >56 points using weighted criteria, comprising clinical features, associated metabolic disorders, and results of laboratory and imaging investigations, can be used to classify as CPPD disease. These criteria had a sensitivity of 92.2% and specificity of 87.9% in the derivation cohort (190 CPPD cases, 148 mimickers), whereas sensitivity was 99.2% and specificity was 92.5% in the validation cohort (251 CPPD cases, 162 mimickers). CONCLUSION: The 2023 ACR/EULAR CPPD disease classification criteria have excellent performance characteristics and will facilitate research in this field.

The 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease.

OBJECTIVE: Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease. METHODS: Supported by the ACR and EULAR, a multinational group of investigators followed established methodology to develop these disease classification criteria. The group generated lists of candidate items and refined their definitions, collected de-identified patient profiles, evaluated strengths of associations between candidate items and CPPD disease, developed a classification criteria framework, and used multi-criterion decision analysis to define criteria weights and a classification threshold score. The criteria were validated in an independent cohort. RESULTS: Among patients with joint pain, swelling, or tenderness (entry criterion) whose symptoms are not fully explained by an alternative disease (exclusion criterion), the presence of crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid are sufficient to classify a patient as having CPPD disease. In the absence of these findings, a score>56 points using weighted criteria, comprising clinical features, associated metabolic disorders, and results of laboratory and imaging investigations, can be used to classify as CPPD disease. These criteria had a sensitivity of 92.2% and specificity of 87.9% in the derivation cohort (190 CPPD cases, 148 mimickers), whereas sensitivity was 99.2% and specificity was 92.5% in the validation cohort (251 CPPD cases, 162 mimickers). CONCLUSION: The 2023 ACR/EULAR CPPD disease classification criteria have excellent performance characteristics and will facilitate research in this field.

[Non-pharmacological management for inflammatory rheumatic diseases]. / Traitements non médicamenteux des rhumatismes inflammatoires chroniques.

Chronic inflammatory arthritis are conditioners with many drug treatments available. However, many patients still suffer from symptoms impairing their quality of life. It seems necessary to propose complementary therapies favoring patients' involvement in their management. We detail several axes: nutrition and micronutrition, physical activity, management of comorbidities such as obesity, smoking and periodontitis as well as physical therapies with cryotherapy and occupational therapy.

Les rhumatismes inflammatoires chroniques sont des maladies fréquentes avec de nombreux traitements médicamenteux à disposition. Toutefois, un nombre significatif de patients conservent des symptômes qui altèrent leur qualité de vie. Il paraît nécessaire de proposer des thérapies complémentaires adaptées à chaque patient en l'impliquant dans sa prise en charge. Nous détaillons ainsi plusieurs axes : la nutrition et la micronutrition, l'activité physique, la prise en charge des comorbidités telles que l'obésité, le tabagisme et la parodontite, ainsi que les thérapies physiques avec la cryothérapie et l'ergothérapie.

[Management of comorbidities in patients suffering from inflammatory rheumatic diseases]. / Prise en charge des comorbidités chez les patients souffrant d'un rhumatisme inflammatoire.

In comparison to the general population, chronic inflammatory rheumatic diseases are more often associated with various comorbidities. Due to the important impact of these pathologies on the quality of life, on the choice of treatment and on the response to the latest, they need to be searched for actively. In this article, we present some of these comorbidities, as well as propositions for their management. We discuss the cardiovascular diseases, neoplasia, infections, interstitial lung disease and osteoporosis.

Les maladies rhumatismales inflammatoires (MRI) sont plus fréquemment associées à certaines comorbidités par rapport à la population générale. Ces pathologies doivent être activement recherchées en raison de leur impact sur la qualité de vie des patients, et car elles peuvent influencer nos choix thérapeutiques. Nous présentons ici cinq comorbidités importantes et leur prise en charge spécifique, à savoir les maladies cardiovasculaires, les néoplasies, les infections, les maladies interstitielles pulmonaires et l'ostéoporose.

Cortical Bone Microarchitecture in Dialysis Patients.

BACKGROUND: The incidence of skeletal fractures is high in dialysis patients. Current available tools are insufficient to predict bone fragility. We analyzed the microarchitecture in patients on dialysis therapy using bone biopsies and peripheral microcomputed tomography. METHODS: We analyzed 12 trans-iliac bone biopsies of patients with recent fractures. Bone microarchitecture was assessed in the bone cores by histology (2D-), microcomputed tomography (3D-µCT), and high-resolution peripheral quantitative computed tomography (HR-pQCT) at the tibia. RESULTS: Trabecular bone volume/tissue volume was similar in 2D histology and 3D-µCT (p = 0.40), while lower in HR-pQCT (p < 0.01). There was no correlation in trabecular microarchitectural indices between 2-histology and 3D-µCT, or HR-pQCT. The 3D-µCT cortical thickness (Ct.Th) were positively correlated with 2D (p < 0.05), but with HR-pQCT (p = 0.33). Ct.Th was lower in patients with ≥2 vertebral fractures than with one fracture. CONCLUSIONS: 3D-µCT is a reliable method for the measurement of cortical bone in bone biopsies. Prospective studies are awaited to address its value in discriminating fracture risk.